Alcoholic cardiomyopathy - Causes, symptoms and treatment. MF.

Causes
Symptoms
Diagnosis
Treatment
Lifestyle
Complications and Forecast

From time immemorial, a person resorts to alcohol to relieve emotional tension, relax, forget current difficulties or note some joyful event. Indeed, sometimes skip a glass - another alcoholic drink will not hurt. But, unfortunately, it often happens that first a person drinks alcohol occasionally, a couple of times a month, then more often, a couple of times a week, then every day. Subsequently, no euphoria and relaxation of alcohol does not bring, but only exacerbates health problems. We will not dwell on the problem of pathological craving for alcohol, but only consider some aspects of the negative influence of alcohol on the human body. Let's look at the bottom of the glass, in which a person drowns his troubles and joys?

Ethanol, contained in any alcoholic beverage, is absorbed into the blood after a few minutes, and under the influence of enzymes it is processed into the body in a very toxic substance - acetaldehyde. This substance can not immediately be excreted from the body, but circulates from five to eight hours in the vascular bed. It is clear that during this time alcohol has a damaging effect on the inner tender lining of the vessels( endothelium), on the inner shell of the heart( endocardium) and the cardiac muscle( myocardium).If a person pours alcohol on a small scratch or wound on the skin, this will cause unpleasant sensations - the wound plaits or can cause severe pain. It is not difficult to guess that alcohol in large quantities with constant use simply "eats away" the blood vessels and the heart from the inside.

Meanwhile, scientists have proven that daily consumption of one to three doses of alcohol( 10 to 30 grams of pure ethanol) can reduce the risk of cardiovascular disease and cardiac death. This phenomenon is called the "French paradox", since in France it is customary to consume red and dry wines daily. Safe is the daily intake of dry wine in a dose not exceeding 240 ml, cognac and vodka - 75 ml. For women, these dosages should be reduced in half because of the greater toxicity of alcohol in the female body.

In Russia, however, other statistics, related primarily to the peculiarities of our mentality. A Russian person, as a rule, does not know the sense of proportion in the use of alcoholic beverages, the more often he resorts to the help of strong spirits( vodka, cognac, moonshine) in doses exceeding harmless. In addition, in recent years, more and more popular is the frequent use of beer in large quantities by men, women, and even adolescents. People mistakenly believe that if beer is not a strong alcoholic drink, then it can not bring harm. However, beer contains, in addition to ethanol, many other dangerous substances, such as, for example, cobalt, which is added to improve foaming. Cobalt compounds have a direct damaging effect on the myocardium.

With the systematic use of alcohol, the brain, heart and liver suffer most. With prolonged heart damage by products of ethanol metabolism, alcoholic cardiomyopathy develops in the body.

Causes of the disease

Alcoholic cardiomyopathy is a disease that develops with the regular use of alcohol and is caused by the destruction of cellular structures and the violation of metabolism in the cells of the heart muscle with their subsequent structural rearrangement, and also characterized by the expansion of the heart chambers and manifested by symptoms of heart rhythm disorders and heart failure. Observed in 50% of patients who consume more than 150 ml of alcohol daily in terms of pure ethanol, more often in males 45 to 50 years.

Symptoms of myocardial damage often develop in a period of not less than ten years of systematic alcohol abuse, but can develop already after 4 to 5 years. Often, heart disease develops faster than cirrhosis of the liver, and accompanies lesions of the nervous system with alcoholic psychoses, "white" fever, etc.

The risk factors of the patient, such as obesity, hypertension, coronary heart disease, diabetes mellitus, weighed heredity for sudden cardiac death, can influence the development of cardiomyopathy.

Symptoms of alcoholic cardiomyopathy

The first symptoms of the disease can appear already in 4 to 5 years after the systematic abuse of alcohol. Clinical manifestations may differ depending on the stage of the process:

1. At the stage of functional disorders , which can last over ten years, the patients note such signs:
- vegetative disorders of the vessels and nervous system - sweating, heat, hand tremor, coldness of the skin of the extremities, persistent redness of the skinface, emotional arousal or inhibition, sleep disorders,
- from the heart - sensation of air shortage, persistent pain in the heart, unrelated to physical exertion, occipital headaches, nausea andwax associated with high blood pressure,
- symptoms of transient or persistent rhythm disorders - a sense of fading, a "turning over" of the heart, a feeling of cardiac arrest followed by a rapid heartbeat is characteristic of ventricular extrasystole, sudden acceleration of the heart rhythm with a frequency of more than 120 per minute maybe symptoms of atrial fibrillation or ventricular tachycardia. Arrhythmias can occur suddenly and cause severe discomfort( paroxysmal forms) or exist permanently - permanent forms.

2. Persistent hypertrophy( increase in mass) or dilatation( expansion of the chambers) of the heart .It manifests as signs of stagnation of blood in the heart and internal organs, the expressed heart failure develops. The development of insufficiency is also caused by rhythm disturbances, which by this time take a persistent character and lead to myocardial wear. Symptoms are as follows:
- constant shortness of breath with the slightest movement activity and at rest,
- swelling of the face, shins and feet,
- cyanotic staining of fingertips, nose, ears, enlarged capillary network at the nose( red veins and bluish nose)
- impaired urination due to impaired circulation in the kidneys,
- abdominal enlargement due to blood congestion and edema of liver parenchyma,
- neurologic symptoms due to encephalopathy and venous congestion in the brain - aggression, irritability, embitteredspine, hand tremors, unsteady gait, insomnia.

3. Severe myocardial dystrophy and all internal organs of .Changes in internal organs are due not only to the inability of the heart to pump blood through the body, which causes circulatory disorders at the level of the smallest vessels in each organ and oxygen starvation of cells, but also the direct toxic effect of ethanol on cells. There is a death of cells of the liver, brain, kidneys, pancreas. Clinically, this is manifested by severe depletion of the patient, swelling of the skin of the hands, feet, face, swelling of the internal cavities of the body( ascites, hydrothorax).The patient is disturbed by severe shortness of breath at rest, an obsessive suffocating cough, frequent episodes of cardiac asthma with the inability to breathe in the prone position, low blood pressure. Chronic poisoning of the body with alcohol and depletion of the heart muscle lead to significant circulatory disorders and to the death of the patient.

Diagnosis of alcoholic cardiomyopathy

For each patient with this disease, a psychiatrist - narcologist is required to choose the optimal treatment for alcohol dependence. Often patients hide their addiction, so if a patient suspects alcoholic heart disease, the doctor should ask the patient's relatives.

It is possible to suspect alcoholic heart disease in a clinical picture, confirmed by echocardiography, with negative rheumatological tests, normal thyroid hormone and adrenal glands, that is, when hypertrophic cardiomyopathy due to heart defects, dyshormonal, postmiocardic and other cardiomyopathies is excluded, especially if the patient is not deniedthe fact of the constant use of alcohol.

To clarify the degree of cardiac dysfunction, the following methods are used:
- echocardiography - is used to determine the size of the heart, the volume of the chamber chambers, the thickness of the myocardium. With alcohol damage, dilation of the chambers with an increase in their volume is more common than hypertrophy( thickening) of the myocardium. A decrease in the ejection fraction( less than 55%) and a general decrease in the contractile function of the myocardium are characteristic.
- ECG, 24-hour Holter monitoring, ECG with dosed physical activity, ECG after transesophageal cardiac electrostimulation - used to clarify the nature of cardiac rhythm disturbances.
- pi radiography of the thoracic cavity organs, there can be a clear increase in the shadow of the heart, as well as signs of venous congestion in the lungs( enhancement of the pulmonary pattern).
- in the general analysis of blood there may be a slight or severe decrease in hemoglobin( anemia), in the general analysis of urine, the appearance of protein, bilirubin due to alcohol damage to the kidneys and liver and venous stasis in them.
- in the biochemical analysis of blood, a decrease in the total protein, an increase in bilirubin, an increase in hepatic enzymes( ALAT, ASAT) and renal parameters( urea, creatinine), an increase in alkaline phosphatase. Specific markers of alcoholic illness do not exist.
- ultrasound of the liver, pancreas, kidneys reveal violations of varying degrees - from mild diffuse changes to cirrhosis and pancreatic necrosis( "dying" of the pancreas)
- ultrasound of the thyroid and adrenal glands in conjunction with hormonal blood tests can identify violations that entaileddevelopment of dyshormonal cardiomyopathy, that is, they help in differential diagnosis.

Treatment of alcoholic cardiomyopathy

The main principle of treatment of the disease is a complete refusal of alcohol. It is proved that stopping the use of alcohol stops the progression of violations of the heart, cirrhosis and pancreatic lesions. But the regress of symptoms is observed only in the early stages of cardiomyopathy. Naturally, in the third stage, the functions of the heart have already been violated so much that it is possible to maintain its work only with the help of a long and continuous intake of medications.

At the first stage of the disease, the following groups of drugs are sufficient:

- vitamins, microelements and cardioprotectors improve metabolic processes in the cells of the heart muscle, normalize the heart rhythm, eliminating unpleasant symptoms of tachycardia. These include vitamins A, E, C, vitamins of group B( cyanocobalamin, pyridoxine, thiamine, riboflavin), nicotinic and folic acids;preparations of potassium and magnesium( panangin, asparcum, magnerot);mexidol, Actovegin courses.
- anti-hypertensive agents( enalapril, pre -arrhythmia, noliprel and others) and antiarrhythmics( cordarone, anaprilin, propranolol, etc.) are used to normalize blood pressure and prevent rhythm disturbances.

In the second and third stages,
diuretics - diuretics( indapamide, lasix, veroshpiron, etc.),
- cardiac glycosides( digoxin, korglikon) are indicated for continuous reception with a constant form of tachyarrhythmias, as well as intravenously for arresting paroxysmsarrhythmia in an ambulance or hospital setting. Exceeding the dose prescribed by the doctor is unacceptable in connection with the development of cardiotoxic effect( glycoside intoxication).

In addition, with concomitant ischemic heart disease, obesity and cholesterol metabolism disorders:
- statins - drugs normalizing blood cholesterol level - atorvastatin, rosuvastatin, etc.
- nitrates - nitroglycerin for tongue, nitrosorbide, pectrol, cardiote forlong-term use of
- antiplatelet agents and anticoagulants( aspirin, tromboass, acetcaridol, aspicor, warfarin, plavix, etc.) prevent the formation of thrombi and the development of thromboembolic complications.

Lifestyle in alcoholic cardiomyopathy

The patient should comply with the following recommendations:

1. The right variety of food:
- complete refusal of alcohol! , smoking restriction,
- it is recommended to get enough food from the food( 90-100 grams per day in the proportion of 50/50 animal and vegetable origin), fats( 70-80grams per day) and carbohydrates( 300 grams per day)
- 4 - 6 meals a day in small portions,
- preference is given to dishes cooked in steam, stewed, boiled, roasted dishes are excluded,
- fatty, salty,spicy dishes,
- eggs, lard, margon, fatty meat and poultry, confectionery, chocolate, coffee,
- limited consumption of liquid not more than 1.5 liters per day, table salt not more than 3 gr per day,
- fresh fruit, berries and vegetables, freshly squeezed juices, fruit drinks are welcome, jellies, compotes, low-fat meat, fish and poultry, sea fish( salmon, mackerel), bread, cereals, sour-milk products, potatoes.
2. Sufficient physical activity - walking walks, fishing, hiking for mushrooms, berries
3. Sufficient sleep - at least 8 hours of night sleep, rest during the daytime
4. Restriction of stress situations , exclusion of heavyphysical work
5. Course or continuous reception of medications as prescribed by the treating doctor

Complications of alcoholic cardiomyopathy

In patients with alcoholic myocardial damage,
- life-threatening arrhythmiasI - ventricular fibrillation, in the absence of medical care leading to cardiac arrest. Clinically manifested sudden deterioration of health, a very frequent pulse( more than 200 per minute), after a few seconds or minutes of his changing absence with a stop of breathing and cardiac activity. Prevention is the timely access to a doctor if there is a breakdown in the heart and taking antiarrhythmic drugs prescribed by a doctor.
- thromboembolic complications of develop often in cardiomyopathy due to the formation of thrombi in the slowly moving blood chambers. A thrombus can "come off" from the wall of the heart and carry a current of blood in the arteries of the brain, kidneys, coronary arteries, a burr, femoral artery. In such cases, ischemic stroke, acute renal failure, myocardial infarction, intestinal necrosis, and thrombosis of lower limb arteries, respectively, will develop. These diseases can end fatal or lead to loss of health and disability of the patient. Prevention - the reception of anticoagulants and antiaggregants according to the prescribing physician.

Forecast

Prognosis for complete refusal of alcohol, timely detection of the disease( in the first and second stages) and timely treatment started is favorable.

If the patient continues to consume alcohol even in the third stage of the disease, he significantly shortens his life expectancy. Mortality in the first 5 - 6 years from the onset of clinical manifestations is 40 - 50%.12 - 22% of alcoholics die precisely because of cardiomyopathy. In 35% of cardiomyopathy leads to sudden cardiac death.

Temporary disability on sick leave for working citizens is determined for a period that requires examination and treatment in a hospital( 10-14 days), with complicated forms - up to three months. If, at the end of this time, the labor forecast is questionable, the patient is referred to the Ministry of Health to determine the disability group. In case the patient develops II A and has a higher stage of chronic heart failure, he can be assigned I or II group of disability. For working citizens with the III( working) group, working conditions should not be heavy - heavy physical work is prohibited, night work, two or more shifts in a row, travel on official business, work that assumes being at the height( painters, window cleaners), long walking on foot( postmen, couriers).Naturally, people with alcohol dependence are prohibited from working in socially significant areas( public transport drivers, pilots, train drivers, electric trains, etc.).

Physician therapist Sazykina O. Yu.